Today we’re going to head down to our doctor’s office with a complaint that he hears all too often: we have pain. We’re tired. We get headaches, and our hands and feet might be numb in the morning. And along with that pain comes some stiffness. It’s like, “Doc, I just don’t feel all that great.” Don’t fret, because the doctor has heard it all before. But also don’t expect to be able to guess what your doctor is going to say. The diagnosis of fibromyalgia — nonspecific pain that doesn’t seem to have any particular source — is as controversial as just about any other subject at your doctor’s office. Some believe it’s a real physical condition, some believe it’s purely psychogenic, and some think it doesn’t exist at all. What is really known about this popular but vague diagnosis?

Everything about fibromyalgia is rife with red flags. Sham treatments for it are offered in magazine ads and on late-night television infomercials. You’ll see it advertised on billboards. Books, websites, special diets, and worthless supplements are all marketed to sufferers just as aggressively as is the condition itself — the more people can be convinced that they have it, the more products they’ll buy. Chapter and verse, fibromyalgia bears every single warning sign of a pseudoscience. But where it veers from this course and enters the realm of real science is that a growing number of medical researchers believe there is something real here, and some cases are now even proving to be treatable.

Much of the time, when we discuss the subject of whether conditions have a psychological cause or a physiological cause, we find a general trend that psychogenic conditions are best treated by psychotherapy, and physiological conditions are best treated with non-psychiatric medicine. Fibromyalgia appears to be a rare exception to this rule. Its causes have not been determined to be purely psychological, but it does seem to be best treated with psychiatric medicine, including both antidepressants and psychotherapy.